On Immunity: An Inoculation

by Eula Biss

Polio’s ability to spread across national borders is part of what makes vaccine refusal a viable weapon in international warfare.

The best I could do, I determined, was hope that my own child’s body might help shield them from disease. If vaccination can be conscripted into acts of war, it can still be instrumental in works of love.

Wealthier countries have the luxury of entertaining fears the rest of the world cannot afford.

Immunity is a public space. And it can be occupied by those who choose not to carry immunity. For some of the mothers I know, a refusal to vaccinate falls under a broader resistance to capitalism. But refusing immunity as a form of civil disobedience bears an unsettling resemblance to the very structure the Occupy movement seeks to disrupt—a privileged 1 percent are sheltered from risk while they draw resources from the other 99 percent.

refusal of vaccination undermines a system that is not actually typical of capitalism. It is a system in which both the burdens and the benefits are shared across the entire population. Vaccination allows us to use the products of capitalism for purposes that are counter to the pressures of capital.

That so many of us find it entirely plausible that a vast network of researchers and health officials and doctors worldwide would willfully harm children for money is evidence of what capitalism is really taking from us. Capitalism has already impoverished the working people who generate wealth for others. And capitalism has already impoverished us culturally, robbing unmarketable art of its value. But when we begin to see the pressures of capitalism as innate laws of human motivation, when we begin to believe that everyone is owned, then we are truly impoverished.

Caretaking, she suggests, is not an inherent threat to liberty. “From a feminist, caring framework,” Peterson writes, “liberty is not defined as complete separation and independence from the parent.” If fathering still reminds us of oppressive control, mothering might help us imagine relationships based not just on power, but also care.

“If you’re going to get medical care,” my father says, “you’re going to have to trust someone.”

Studies had shown, he told me, that the body language and facial expressions of anxious mothers can cause children to fear surgery and resist anesthesia. It seemed there were two ways to interpret those findings, I told him—one could determine that the mother’s presence is not good for the child, or one could conclude that ensuring the confidence of the mother is essential to the well-being of the child.

“Where there is trust, paternalism is unnecessary,” the philosopher Mark Sagoff writes. “Where there is no trust, it is unconscionable.” And so we are caught in a double bind.

Infants are exposed to an onslaught of bacteria the moment they leave the womb, even before they exit the birth canal. Any infant who does not live in a bubble is likely to find the everyday work of fighting off infection more taxing than processing weakened antigens from multiple immunizations.

“Who ever goes into science,” he asks, “thinking, God, if I could just figure out which of these two viral surface proteins evoke neutralizing antibodies, I’ll be rich beyond my wildest dreams!” He would have made a much better salary, he observes, if he had gone into private practice as a pediatrician after medical school rather than going into research.

Once you are infected with chicken pox, the varicella virus never leaves your body. It lives in your nerve roots and must be kept at bay by your immune system for the rest of your life. In times of stress, it can return as shingles, a painful inflammation of the nerves. The reawakened virus can cause strokes and paralysis, but the most common complication of shingles is nerve pain that persists for months or years. Immunity produced by disease, in this case, involves an ongoing relationship with the disease. The vaccine virus that protects against chicken pox can also remain in a person’s nervous system. But being a weakened virus, it is far less likely to reawaken as shingles. And when it does, it is less likely to cause a severe case of shingles.

We are wary of imitations, even when they offer improvements.

“Morality can’t be fully private,” my sister tells me, “for many of the same reasons that a language can’t be fully private. You can’t be intelligible only to yourself. But thinking of the conscience as a private sense of right and wrong suggests that our collective understandings of justice can be insufficient.

“You don’t own your body—that’s not what we are, our bodies aren’t independent. The health of our bodies always depends on choices other people are making.” She falters for a moment here, and is at a loss for words, which is rare for her. “I don’t even know how to talk about this,” she says. “The point is there’s an illusion of independence.”

In response to a 1912 definition of biological individuality as the quality of being “rendered non-functional if cut in half,” Donna Haraway observes that this requirement of indivisibility is problematic for both worms and women. “That, of course,” Haraway writes, “is why women have had so much trouble counting as individuals in modern Western discourses. Their personal, bounded individuality is compromised by their bodies’ troubling talent for making other bodies, whose individuality can take precedence over their own, even while the little bodies are fully contained.” One of our functions, as women, is to be divided.

Queen Elizabeth expressed a paradox that eludes us to this day—our bodies may belong to us, but we ourselves belong to a greater body composed of many bodies. We are, bodily, both independent and dependent.

British antivaccinators in the nineteenth century compared their movement to the Irish Home Rule movement, conflating the governance of a country with the governance of a body. We resist vaccination in part because we want to rule ourselves. Attitudes toward the state easily translate into attitudes toward vaccination, in part because the body is such a ready metaphor for the nation.

“Why target two and a half million innocent newborns and children?” Barbara Loe Fisher asks of the hep B vaccine. The implication behind the word innocent is that only those who are not innocent need protection from disease. All of us who grew up during the AIDS epidemic were exposed to the idea that AIDS was a punishment for homosexuality, promiscuity, and addiction. But if disease is a punishment for anything, it is only a punishment for being alive.

Alice’s bewilderment and disorientation, which I had anticipated might speak to my son’s experience of being a child in an adult’s world, spoke instead to my own experience navigating the world of information. Being lost in Wonderland is what it feels like to learn about an unfamiliar subject, and research is inevitably a rabbit hole.

Now a bit of computer code or the content of a website can be viral. But, as with the kind of virus that infects humans, this content cannot reproduce without hosts. Misinformation that finds a host enjoys a kind of immortality on the Internet, where it becomes undead.

Knowledge is, by its nature, always incomplete.

The number of lives a disease claims, as Susan Sontag observes, is not what makes it a plague. In order to be promoted to plague, a disease must be particularly feared or dreaded.

Perhaps the final qualification for what constitutes a plague is its proximity to your own life.

The persistence of resistant bacteria and the emergence of novel diseases are among the top public health threats of the twenty-first century.

In the past century there have been three major influenza pandemics, including the 1918 Spanish flu pandemic, which killed more people than the First World War. That pandemic proved particularly deadly for young adults with strong immune systems, as it caused an overwhelming immune response. In 2004, the director of the WHO announced that another major pandemic is inevitable. “It’s not a matter of if, but when,” a bioethicist friend tells me.

The pandemic was not as bad as it could have been, but it was not inconsequential. Somewhere between 150,000 and 575,000 people died from H1N1, over half in Southeast Asia and Africa, where public health measures were scarce. Autopsies suggest that many of the previously healthy people who died of the flu were killed by their immune response—they drowned in their own lung fluid.

“Apocalypse,” Sontag writes, “is now a long-running serial: not ‘Apocalypse Now’ but ‘Apocalypse From Now On.’ Apocalypse has become an event that is happening and not happening.” In this era of uncertain apocalypse, my father has taken to reading the Stoics, which is not an entirely surprising interest for an oncologist. What he is drawn to in their philosophy, he tells me, is the idea that you cannot control what happens to you, but you can control how you feel about it. Or, as Jean-Paul Sartre put it, “Freedom is what you do with what’s been done to you.”

As mothers, we must somehow square our power with our powerlessness. We can protect our children to some extent. But we cannot make them invulnerable any more than we can make ourselves invulnerable. “Life,” as Donna Haraway writes, “is a window of vulnerability.”

The reasons people give blood cannot be explained by personal gain, that much we know.

The study looked at two groups of people, one vaccinated against the flu and the other not vaccinated. After both groups were asked to read an article exaggerating the threat posed by the flu, the vaccinated people expressed less prejudice against immigrants than the unvaccinated people.

The concept of self is fundamental to the science of immunity, and the dominant thinking in immunology is that the immune system must discriminate between self and nonself, and then eliminate or contain the nonself within protective barriers.

The womb is sterile, and so birth is the original inoculation. Passing through the birth canal, an infant is introduced to the microbes that will inhabit that infant’s skin and mouth and lungs and gut for years to come. From birth onward, our bodies are a shared space.

Diversity is essential to the health of any ecosystem. But the language we use around racial diversity, particularly the word tolerance, tends to imply that other people are essentially a nuisance, and disguises the fact that we need and depend on each other.

Immunity is a shared space—a garden we tend together.